| NPI | 1417017104 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: TX H9446) | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX H9446) | 
| Enumeration Date | 2006-12-11 | 
| Last Update Date | 2025-10-07 |